Provider Demographics
NPI:1962431874
Name:REHAB MEDICAL OF ATLANTA, LLC
Entity type:Organization
Organization Name:REHAB MEDICAL OF ATLANTA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEARHEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-813-4210
Mailing Address - Street 1:3750 PRIORITY WAY SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3831
Mailing Address - Country:US
Mailing Address - Phone:317-436-6178
Mailing Address - Fax:855-671-9194
Practice Address - Street 1:5875 PEACHTREE INDUSTRIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3600
Practice Address - Country:US
Practice Address - Phone:404-320-9150
Practice Address - Fax:404-320-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
GA302974078332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6383130001Medicare NSC